Traditional Case Manager

Life Goes On Case Management Services, LLC (LGO) has provided quality care and services to individuals with physical, mental and emotional disabilities for over 25 years. Our skilled team of social workers and life skills coaches have extensive experience working with persons with various mental and physical disabilities. We employ a multidisciplinary approach to service delivery and understand that each client is unique. Therefore, services are on an individualized basis to include: 

• Case Management 

• Counseling 

• Resource and Referral 

• Goals Assessment 

• Care Plan Facilitation 

• Assistance with housing/income 

• Assistance with Medicaid Application 

SUMMARY/OBJECTIVE The Case Manager is responsible for intensive case management services provided to the membership of Independent Care Waiver Program (ICWP) requiring face to face and telephonic meetings with members within the framework of the Care Plan. 

ESSENTIAL FUNCTIONS/RESPONSIBILITIES: 

• Long term services and supports clinical and diagnostic assessments and care planning for members with complex and chronic conditions including performing and arranging for waiver services and personal care assistance. 

• Refer members to community resources for the appropriate agencies and organizations to enhance and supplement services for the member. Examples: Community Mental Health, Area Agency on Aging, Local Health Departments, Meals on Wheels and Transportation. 

• Initiates and implements an individual plan of care with attainable goals in conjunction with the member, health care providers, and community agencies. Modifies the plan of care through monitoring and re-evaluation to accommodate changes in treatment or progress for all assigned clients. 

Appendix A 

• Care coordination contacts include telephonic and face-to-face interaction with members in their homes, inpatient and outpatient settings, and institutional settings. Face-to-face interaction is more frequent than at the Care Coordinator I level. 

• Participates in the development, implementation and evaluation of the client’s care plan care in accordance with ICWP Policies and Medicaid requirements within the Case Management Program. 

• Performs on-going evaluation of quality and cost effectiveness of Case Management Services. 

• Documents care in accordance with LGO and ICWP Policies. 

• Maintains statistical data, reports and logs as required. 

• Works with the Concurrent Review Nurse on evaluations of hospitalized members in need of discharge planning, transitions of care, medication reconciliation, and case management. 

• Works with the Referral Coordinator to ensure the member receives the correct and cost effective DME. 

• Interacts with Vendors, Specialists and Primary Care Physicians to authorize and coordinate services for members. 

• Presents medically complex questionable cases to the Georgia Medical Care Foundation (GMCF). 

• Assures maintenance and sharing of records, reports and assures HIPPA compliance. 

• Attends identified Plan Committee and Staff Meetings. 

• Other duties as assigned. 

ADDITIONAL FUNCTIONS/RESPONSIBILITIES: 

• Conduct supervision for Case Managers who work with traditional ICWP clients. 

• Review case notes for detail, continuity and completion of follow up.

• Collaborate with Case Managers to complete follow-up on incident reports in a timely manner for all traditional ICWP clients. 

• Coordinate and conduct one (1) to two (2) Case Manager trainings per month. 

EDUCATION/EXPERIENCE REQUIRED: 

• Licensed as a registered nurse or have a BA or BS degree in a health care or human services related discipline from an accredited college or university. 

• Three years of experience in healthcare service delivery or human services case management pertinent to the disabilities and conditions of the populations served by the Independent Care Waiver Program; severely disabled adults and adults with traumatic brain injuries. 

• Medicaid/Medicare and/or HMO experience (Managed Care experience), preferred. 

• Experience with GAMMIS, preferred. 

• Participate in Performance Measurement Criteria by cost reductions, admission statistics, accuracy of data, and accuracy of interpretation of case management and concurrent reviews. 

• Self-starter who is analytical, organized, intuitive, and investigative. 

• Good written and interpersonal communication skills. 

• Strong problem-solving skills, extensive telephone involvement and Care Management coordination. 

Appendix A 

• Manual dexterity to operate PC (MS Word, Excel). 

• Excellent customer service. 

• Knowledge of medical terminology and ICD-9 and CPT coding, preferred.

 CERTIFICATIONS/LICENSURES REQUIRED: 

• Georgia Driver’s Licenses without restrictions. 

• Have regular access to a registered vehicle with no fault insurance coverage in your name. 

• Certified Case Manager, preferred. 

DIRECTLY REPORTS TO: Case Manager Supervisor 

JOB CLASSIFICATION: Non-exempt, hourly Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at anytime with or without notice.